PA/LTC Perspective

Abstract

Health and Human Services Secretary Sylvia M. Burwell recently announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the value of care delivered, defined by the Centers for Medicare & Medicaid Services as care that is delivered at the lowest cost while preserving the best health outcomes, rather than the volume or quantity of care they give patients. HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as accountable care organizations or bundled payment arrangements by the end of 2016, and tying 50% of payments to these models by the end of 2018. HHS also set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs such as the hospital value-based purchasing and the hospital readmissions reduction programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments. To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network. Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. HHS will intensify its work with states and private payers to support adoption of alternative payment models through their own aligned work, sometimes even exceeding the goals set for Medicare. The Network is expected to announce more details in the near future. Although we support the general direction and purposes of value-based medicine and new payment models, they have not considered how to integrate PA/LTC and have not thought out the implications the current proposed models will have, some of which are quite negative. AMDA is advocating for appropriate quality measures that truly reflect quality in our population, and means to accurately compare costs to incentivize meaningful change. The construction of bundled payment models may offer unique opportunities for collaboration between various sites of service and providers – but only if done correctly. AMDA has noted in its previous comments and conversations with CMS that the current implementation of value-based programs do not properly align incentives across providers (clinicians and facilities), and some programs, like the value-based payment modifier, create barriers to practice due to improper quality/cost measure benchmarking. AMDA has a longstanding mission of improving quality in the PA/LTC sector and looks forward to working with HHS to achieve these goals. To read more about why this matters: www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-2.html.